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4 - CPT > Hypertension and Heart Failure > Flashcards

Hypertension and Heart Failure Flashcards

1
Q

Describe the different grades of hypertension

A
  • Hypertension defined as 140/90 mmHg
  • Grade 1: 140-159 / 90-99 mmHg
  • Grade 2: 160-179 / 100-109 mmHg
  • Grade 3: > 180 / >110 mmHg
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2
Q

List some non-pharmacological management of hypertension

A
  • Patient education
  • Maintain normal body weight and BMI
  • Reduce salt intake to < 6g/day
  • Limit alcohol consumption to < 3units/day for men and < 2 units/day for women
  • Engage in regular aerobic physical exercise for > 30 minutes/day
  • Consume > 5 portions of fresh fruit/vegetables daily
  • Reduce intake of total and saturated fat
  • Smoking cessation
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3
Q

List the main classes of antihypertensive drugs

A
  • ACE inhibitors
  • Angiotensin receptor blockers
  • Calcium channel blockers
  • Diuretics
  • Alpha and beta blockers
  • Direct renin inhibitor
  • Centrally acting agents
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4
Q

Describe the mechanism of ACE inhibitors

A
  • Eg. Ramipril, lisinopril
  • Competitive inhibitor of angiotensin converting enzyme
  • Reduction in formation of angiotensin II
  • Arterial vasodilators
  • Some venodilation
  • Circulating aldosterone is reduced
  • Potentiates the action of bradykinin (stops breakdown of bradykinin) - vasodilator
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5
Q

List the main ADRs of ACE inhibitors

A
  • HARD
  • Hyperkalaemia - reduced Na reabsorption leading to reduced K secretion
  • Angio-oedema - increased circulating fluid
  • Renal failure
  • Dry cough due to bradykinin
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6
Q

Describe the mechanism of angiotensin receptor blockers

A
  • Eg. Losartan, candesartan
  • Bind to angiotensin AT1 receptor
    • Inhibit vasoconstriction and aldosterone stimulation caused by angiotensin II
      • Increased release of NO - vasodilator
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7
Q

List the main side effects of angiotensin receptor blockers

A
  • Renal failure

- Hyperkalaemia - reduced Na reabsorption leading to reduced K secretion

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8
Q

State the 3 classes of calcium channel blockers

A
  • Dihydropyridines
  • Phenylalkylamines
  • Benzothiazepines
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9
Q

Describe the use of dihydropyridines

A
  • Eg. Nifedipine, amlodipine
  • Main calcium channel blocker used in hypertension
  • Baroreflex mediated tachycardia
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10
Q

Describe the main side effects of dihydropyridines

A
  • FOGS
  • Flushing, sweating, throbbing headache
  • Oedema - ankle swelling
  • Gingival hyperplasia - increased size of gums
  • Sympathetic nervous system activation - tachycardia and palpitations
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11
Q

Describe the uses of phenylalkylamines

A
  • Eg. Verapamil
  • Useful in treating angina and arrhythmia
  • Depresses SA node and slows AV conduction
  • Impedes calcium transport across the myocardial and vascular smooth muscle cell membrane
  • Peripheral vasodilation and a reduction in cardiac preload and myocardial contractility
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12
Q

List the main side effects of phenylalkylamines

A
  • Constipation
  • Risk of bradycardia
  • Reduce myocardial contractility (negative inotrope) - can worsen heart failure
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13
Q

Describe the uses of benzothiazepines

A
  • Eg. Diltiazem
  • Impedes calcium transport across the myocardial and vascular smooth muscle cell membrane
  • Prolongs the action potential/effective refractory period - also useful in arrhythmias
  • Peripheral vasodilation and a reduction in cardiac preload and myocardial contractility
  • Not as effective as amlodipine in treating hypertension but less risk of heart failure - used in angina
    • Less cardiac stimulation as side effect
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14
Q

List the main side effects of bezothiazepines

A
  • Risk of bradycardia
  • Congestion, cough
  • Fever, runny nose
  • Less negative inotropic effect than verapamil - can worsen heart failure
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15
Q

State the type of diuretics given as anti-hypertensives and its effect

A
  • Mainly thiazides (bendroflumethiazide, indapamide)
    • Reduces sodium reabsorption, thus reducing blood volume
      • Also acts as vasodilator to lower total peripheral resistance
  • Spironolactone given to secondary hypertension due to hyperaldosteronism
    - Acts as angiotensin receptor blocker
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16
Q

Describe the effect of alpha blockers as antihypertensives and its ADRs

A
  • Alpha blockers antagonize contractile effects of noradrenaline on vascular smooth muscle
    • Reduce peripheral vascular resistance
    • Eg. Doxazosin
  • ADR - postural hypotension, headache and fatigue, oedema
17
Q

Describe the effect of beta blockers as antihypertensives and its ADRs

A
  • Beta blockers reduce heart rate and cardiac output
    • Inhibit renin release
    • Eg. Bisoprolol, atenolol
  • ADR - lethargy, reduced exercise tolerance, bradycardia, cold hands, impaired tolerance
  • Contraindication - asthma
18
Q

Describe the action of direct renin inhibitor

A
  • Eg. Aliskiren

- Binds to renin molecule and prevents cleavage of angiotensinogen to angiotensin I

19
Q

Describe the action of centrally acting agents

A
  • Reduce sympathetic outflow - work in the brain
  • Eg. Methydopa (used in pregnancy), clonidine, moxonidine
  • ADR - lethargy, depression
20
Q

Describe the NICE guidelines on hypertension treatment

A
  • Aged under 55 years give ACEi or ARB first line
  • Aged over 55 or black person of african or caribbean origin give calcium channel blocker first line
    - Have less effective RAAS
  • 2nd line would be to give ACEi/ARB or CCB if not given
  • 3rd line is thiazide diuretic
  • 4th line consider further diuretic or alpha/beta blocker
21
Q

List common causes of heart failure

A
  • Ischaemic heart disease
  • Hypertension
  • Cardiomyopathies - alcohol, idiopathic, chemotherapy, iron overload
  • Valve disease
22
Q

List non-pharmacological measures in treating heart failure

A
  • Reduce salt intake
  • Reduce blood pressure
  • Reduce alcohol intake
23
Q

Describe the first line treatment of heart failure

A
  • ACE inhibitor / Angiotensin receptor blocker (ARB) - commonly given
    • Vasodilation - reduce afterload to ease HF
    • Improve ventricular remodeling
  • ß-blocker - commonly given unless patient is asthmatic
    • Reduce heart rate and blood pressure, which reduces work of heart
    • Also reduces mobilisation of glycogen and negate unwanted effects of catecholamines
    • Have to be careful and initiate at low dose as failing myocardium dependent on heart rate
24
Q

List non-first line medication for heart failure

A
  • Spironolactone - commonly given as HF treatment rather than as diuretic
  • Loop diuretics
  • Ivabradine - inhibition of funny channel reducing heart rate
  • Sucubitril - increase ANP to increase natriuresis and diuresis
  • Antiplatelet drugs
  • Statin

4 - CPT (23 decks)

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